Provider Demographics
NPI:1962968214
Name:SHERRILL-JAMISON, NICOLE (PHD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SHERRILL-JAMISON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 EXECUTIVE PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1833
Mailing Address - Country:US
Mailing Address - Phone:704-939-1100
Mailing Address - Fax:704-939-1173
Practice Address - Street 1:909 S MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-6459
Practice Address - Country:US
Practice Address - Phone:704-267-5957
Practice Address - Fax:704-970-1864
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-23043101YA0400X
NC23043101YA0400X
NC20343101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)